Medicaid plan would transform health care in Florida

WASHINGTON – Florida'sfast-growing Medicaid program -- which cares for the state's impoverished children and for most senior citizens in nursing homes -- would lose roughly a third of its federal money under budget plans embraced by Republican presidential candidate Mitt Romney and his running mate Paul Ryan.

Ryan and his Florida supporters say their version of Medicaid would save states drowning in health-care costs while still helping those most in need. It fits the vision of Gov. Rick Scott, who has refused to expand Medicaid under the new health care law, and Republican legislators, who want to turn the program over to private HMOs.

But critics warn that the Republican plan would devastate a program that serves 3.2 million Floridians and would force the uninsured to seek more costly emergency care while indirectly leading to higher insurance premiums for everyone else.

"In Florida, there's been such an effort to cut the program to the bone as it is that there's not much more they can do without cutting vital services," said Laura Goodhue of Jupiter, executive director of Florida CHAIN, a health-care advocacy group.

Jeannette Ramos, 30, a single college student in Plantation, says Medicaid cutbacks already have made it impossible to get dental care and some medication for her 5-year-old daughter, who has endured seven surgeries and suffers from Down syndrome. Further cuts, she said, "would be a disaster."

"Without Medicaid it would be really difficult for any of our children with special needs to get any kind of services," Ramos said. "Already you can see dentists and other doctors who are not on board any more."

The Republican vision of a smaller and more flexible state-run Medicaid gives voters a sharp contrast to President Barack Obama's attempt to dramatically expand the program to cover a million uninsured Floridians, mostly low-wage families who cannot afford private insurance.

Though overshadowed by political sparring over Ryan's plan to turn Medicare into a voucher-like system, Medicaid has a much bigger impact on the state budget – it cost $21.3 billion last fiscal year, with just over half paid by the federal government -- and on the lives of millions of Floridians. They include middle-class senior citizens who exhaust their savings on health care, families struggling to care for elderly parents, and the long-term unemployed.

Romney is campaigning on his own plan but has endorsed the concept of a budget proposed by Ryan. It would turn Medicaid's open-ended benefits into a smaller "block grant," a set amount sent to states with fewer federal strings attached.

The Ryan plan would cut Medicaid nationwide by $810 billion over 10 years and reduce Florida's allotment by $35 billion by 2022 -- about one-third less than current projected spending -- according to an analysis by Families USA, a nonpartisan advocacy group for health-care consumers. An Urban Institute study found similar results: a 31-percent cutback for Florida by 2021.

The biggest impact may be on those who seek nursing-home care.

About 60 percent of Florida's nursing-home patients – 77,239 in fiscal 2010 -- rely on Medicaid. The cost that year was $2.7 billion, 13 percent of the Medicaid budget, according to the state Agency for Health Care Administration.

"Many would be left out in the cold," said Brian Lee, executive director of Families for Better Care, an advocacy group in Tallahassee for nursing-home residents. "If nursing homes are not getting paid, they aren't going to take them. So it could be a desperate time for potential residents."

A spokeswoman for the industry in Florida said nursing homes cannot expel residents and would not turn away new patients, but she warned that the block-grant proposal would force cuts in staff, transportation, maintenance and patient activities designed to create a homelike environment.

"If we are not able to keep up long-term services, how can we market our state as a place that meets the needs of baby boomers?" said Kristen Knapp, communications director for the Florida Health Care Association, which represents 550 of the state's 682 nursing homes.

The Ryan plan dovetails with attempts by Scott and Republicans in the Legislature to reform Medicaid and reduce its staggering costs.

"I always anticipated that the federal share of Medicaid is going to go down, because the glide path they are on is not sustainable," said state Sen. Joe Negron, R-Stuart, a leader on health-care financing in the Legislature.

Negron said the Ryan plan would allow the state to begin charging Medicaid recipients a small premium – say $10 a month -- and exclude some benefits such as chiropractic care and home-health services.

"I believe the benefits under Medicaid should be equivalent to benefits enjoyed by the taxpayers who are funding Medicaid," Negron said. "Some services that are paid for in a person's home under Medicaid would not be covered in a private plan."